Provider Demographics
NPI:1427805373
Name:THE MANGROVES SEEDS OF CHANGE, LLC
Entity type:Organization
Organization Name:THE MANGROVES SEEDS OF CHANGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:E
Authorized Official - Last Name:JAMESON
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:863-268-5802
Mailing Address - Street 1:148 OAK DR
Mailing Address - Street 2:
Mailing Address - City:CLEWISTON
Mailing Address - State:FL
Mailing Address - Zip Code:33440-9417
Mailing Address - Country:US
Mailing Address - Phone:863-268-5802
Mailing Address - Fax:
Practice Address - Street 1:148 OAK DR
Practice Address - Street 2:
Practice Address - City:CLEWISTON
Practice Address - State:FL
Practice Address - Zip Code:33440-9417
Practice Address - Country:US
Practice Address - Phone:863-268-5802
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health